Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security.

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April 9, 2020

EPI UPDATE The WHO COVID-19 Situation Report for April 8 reported 1,353,361 confirmed COVID-19 cases (73,639 new) and 79,235 deaths (6,695 new). Globally, 5.8% of the total reported cases have died. This value is driven heavily by the volume of cases and deaths in Europe and varies by region:
-Europe: 8.0%
-The Americas: 3.0%
-Western Pacific: 3.4%
-Eastern Mediterranean: 5.3%
-South-East Asia: 4.0%
-Africa: 4.3%

The Russian Ministry of Health reported a total of 10,131 cases (1,459 new), continuing Russia’s recent trend of 16-18% daily increase. Iran reported 66,220 confirmed cases of COVID-19 (1,634 new), including 4,110 deaths (117 new). Iran’s steady decline in daily incidence continues. After several days of increased COVID-19 incidence, Pakistan reported its second consecutive day of fewer than 250 new cases. Yesterday, Pakistan reported 248 new cases, bringing the national total to 4,322 confirmed cases, including 63 deaths (5 new).

After a week of decreasing daily COVID-19 incidence, Spain has reported elevated numbers on 3 consecutive days. Today, Spain reported 5,756 new cases, bringing the national total to 152,446 cases, including 15,238 deaths (683 new). Italy reported more new cases than the previous day (3,836 compared to 3,039), but the daily incidence remains below 4,000 for the third consecutive day after exceeding that number for nearly 3 weeks. Italy is reporting a total of 139,442 confirmed cases, and 17,669 deaths.

Both Japan and India have reported elevated COVID-19 since late March. Excluding cases associated with the Diamond Princess cruise ship, the highest reported daily incidence in Japan before March 24 was 64. Japan jumped to 101 cases by March 25 and has remained above that point since, with multiple days greater than 200. Today , Japan reported 4,768 total cases (511 new). India has consistently reported daily incidence in excess of 500 cases since March 31 , more than double the highest daily total prior to that date. India’s COVID-19 epidemic grew from approximately 1,400 cases to nearly 6,000 over that time (more than 300% increase), according to Johns Hopkins CSSE data. The official India Ministry of Health and Family Welfare data currently indicates 5,218 confirmed cases.

The US CDC reported 395,011 cases (20,682 new) and 12,754 deaths (690 new) on April 8. As of yesterday, 16 states reported more than 5,000 cases (2 new), and 31 states, plus Guam, reported widespread community transmission (1 new, plus Guam). The Johns Hopkins CSSE dashboard is reporting 432,579 US cases and 14,830 deaths as of 10:45am on April 9.

CORONAVIRUS NOT LIKELY TO BE SEASONAL Preliminary analysis by experts at the US National Academy of Sciences suggests that COVID-19 may not exhibit strong seasonality. The study evaluated available observational epidemiological data as well as laboratory experimental data, including studies both in China and other countries. The researchers did not find strong evidence that the pandemic will wane in summer months as due temperature and humidity increase; however, they note that their findings are based on limited preliminary data—some of which is of questionable quality—and that further study is required to better characterize the virus’ transmission patterns. While some data, particularly from laboratory studies, provide evidence supporting seasonality, the researchers note that these are not necessarily representative of the natural environment and that multiple countries currently in their summer season are experiencing significant volume of transmission. Additionally, the researchers cite the global susceptibility to the virus as another major driver of continued global transmission over the coming months.

SECOND US TASK FORCE New reports shared that the US government is planning to institute a second coronavirus taskforce to examine and address the economic impacts of the country’s COVID-19 response. The new task force would reportedly include high-ranking government officials, potentially including some members of the current coronavirus task force, as well as representatives from the private sector, and it could start as early as the end of this week. There has been no official announcement yet, to our knowledge.

YEMEN CEASE-FIRE Following a recent call by UN Secretary General António Guterres for an “immediate global cease-fire” to enable COVID-19 response operations in conflict areas, Saudi Arabia will suspend military operations in Yemen . While no COVID-19 cases have yet been reported in Yemen, conditions in the country—including widespread malnourishment, devastated healthcare infrastructure, and large internally displaced populations—have facilitated major epidemics in recent years, including an ongoing cholera epidemic that has resulted in more than 2.3 million cases and 3,700 deaths nationwide. The cease-fire will commence today and is scheduled to last for 2 weeks—but could be extended.

US RESPONSE CRITICISM We have reported recently on growing tensions between the federal government’s response to the growing US COVID-19 epidemic and state officials, including governors, but healthcare workers on the front lines are expressing concern as well. In a series of interviews, STAT News elicited feedback from healthcare workers across the country regarding the COVID-19 response, and many reportedly expressed frustration with both state and federal responses. Their major concerns included delays in implementing response activities (eg, social distancing), spread of misinformation about the current state of the epidemic and response, supply shortages (eg, personal protective equipment [PPE]), and poor testing availability and strategy. Many healthcare workers feel that insufficient response by government agencies has put them at elevated risk. Additionally, reports continue about the US government “seizing” supplies ordered by states and hospitals. US President Donald Trump and other US government officials have previously called on states and hospitals to acquire their own supplies; however, some orders placed by states and hospitals have reportedly been diverted to the US government, and there appears to be little or no insight into how the government is using or distributing them.

STAT News also published a commentary by Sudip Parikh, CEO of the American Association for the Advancement of Science (AAAS) and Executive Publisher of Science , regarding the role of the US CDC in the COVID-19 response. The commentary laments the reduced public visibility and public engagement from CDC officials and calls for the CDC to assume the role that Americans, and indeed the world, has come to expect. Recently, the CDC has largely been replaced by the White House Coronavirus Task Force as the public-facing source for COVID-19 information from the US government, which has been criticized for its focus on political commentary and misinformation over factual information from health experts.

Following a statement on Tuesday by President Trump that the US government will “put a very powerful hold” US funding for the WHO in response to perceived missteps during the COVID-19 pandemic response, WHO Director-General Tedros Adhanom Ghebreyesus called for political leaders to “quarantine politicizing COVID.” He went on to warn that politicizing the pandemic over prioritizing appropriate response activities could lead to more deaths. Dr. Tedros did not explicitly refer to President Trump or the United States in his statement.

COVID-19 SURVEILLANCE & CONTACT TRACING The San Francisco Department of Public Health is implementing a contact tracing task force to suppor COVID-19 surveillance and response in the city. The task force includes approximately 40 people, including members drawn from non-traditional fields, including library science and university students, and it could potentially grow to as many as 150 people, if needed. As of yesterday afternoon, San Francisco reported 676 positive COVID-19 cases and 10 total deaths.

As efforts to scale up surveillance and contact tracing capacity look to novel solutions, some experts are raising questions about the collection of personal medical and other potentially sensitive data to support these programs. On Tuesday, the US Department of Health and Human Services announced that it would relax enforcement of legislation prohibiting healthcare institutions from sharing patients’ protected medical information as long as it is used for “public health and health oversight activities” related to COVID-19. Additionally, private sector companies have increasing access to medical data through COVID-19 screening apps. Multiple countries—notably, China and South Korea—have utilized smartphone apps and location information to track infected individuals and notify those who may be at risk of exposure. While this concept could automate and accelerate the normally arduous process of contact tracing , it raises concerns about the collection and use of potentially sensitive information, particularly medical and location information. Efforts are ongoing to evaluate the feasibility and benefit of implementing these systems in order to speed up the easing of social distancing measures while mitigating associated concerns about privacy and data security.
NEW YORK OUTBREAK ORIGINATED IN EUROPE Preliminary genomic analyses of SARS-CoV-2 from patients in the New York City area suggests that a significant portion of the circulating virus may be linked to cases in Europe. Two studies (both pre-print) by researchers from Mount Sinai Hospital and the NYU Grossman School of Medicine found that initial cases of COVID-19 in New York likely arrived from Europe as opposed to China. In addition to these statements or the outbreak’s origins, these research teams also suggest that there was a significant amount of viral circulation prior to the earliest detected cases in the city’s outbreak. 

US ECONOMIC EFFECTS The downstream effects of social distancing interventions continue to have substantial effects on the economy. In the United States, a number of investment agencies have offered projections of the decline in the US gross domestic product (GDP) for the second quarter of 2020. These estimates range from drops of 30% to 38% . Notably, the US GDP did not decrease by more than 8% in any quarter during the 2008 Great Recession. Additionally, unemployment is already estimated to be 12-13%. A representative from the Pacific Investment Management Company (PIMCO) suggested that the total national GDP loss could be around 5% for the year as a whole. 

SARS-CoV-2 TRANSMISSIBILITY A new study published in the US CDC’s journal Emerging Infectious Diseases examines the transmissibility of SARS-CoV-2. The study utilized publicly available Chinese case reports, travel volume data, and daily epidemiological reports from early in the pandemic to analyze transmission dynamics. The models suggest that the COVID-19 outbreak in Wuhan, China, had a doubling time (ie, the time required for an epidemic to double in size) of 2.3-3.3 days and an R 0 of 5.7 early in the outbreak, prior to the implementation of social distancing measures. The authors emphasize the importance of maintaining social distancing interventions in order to reduce disease transmission.